Medical News Today: What does it mean when acne is itchy?

People typically associate acne with blackheads, whiteheads, red bumps, pustules, or cystic lesions, all of which may cause pain and irritation. People who experience itchy acne may, therefore, question whether this is normal.

Although people do not generally regard acne as an itchy condition, some individuals may occasionally experience itching or a sensation that causes them to pick at their acne. Usually, the itchiness is due to another skin condition that may also resemble acne. These skin conditions are rarely serious, but they can be bothersome.

It is important to determine the cause of the itching as scratching can damage the skin, resulting in infection and scarring.

In this article, we look at the causes of itchy acne and ways to relieve the itch. We also discuss similar conditions and their treatments.

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Some evidence suggests that many people with acne experience itching. In one 2008 study, 70% of people with acne reported some itching. Another 2008 study found that that mild-to-moderate itching was common among teenagers with acne.

Factors other than acne itself — such as the side effects of medication or acne products — can cause itching or make itching worse. Also, different forms of acne may be more or less likely to itch. The following sections discuss these causes and risk factors.

A side effect of acne treatments

Many ingredients that are effective in clearing acne can also cause dry skin and itchiness as a side effect. Salicylic acid, benzoyl peroxide, and retinoids can all cause dryness, peeling, and itching in some people. These symptoms are usually due to the development of mild irritant contact dermatitis.

In some cases, the dryness and itching may resolve with time and proper moisturizing. However, some people may need to reduce the frequency of use or strength of the product.

People who use prescription retinoids, including tretinoin, may find that starting at a lower strength and gradually increasing it over time can help alleviate some of the itching and dryness. A dermatologist can help a person determine what strength is right for them.

In addition, using the product less frequently can help alleviate any itching, peeling, and dryness. Using the product once a day or every other day and gradually increasing the frequency may allow the skin to adapt to it, which can help reduce itching.

Using moisturizer alongside the treatment may also help.

Dermatologists often recommend that people use gentle cleansers while undergoing acne treatment. Using harsh cleansers can make dryness and irritation worse.

An allergic reaction to acne products

Some people may be allergic to an active ingredient, preservative, or thickening agent in an acne treatment product. As a result, they may find that using it causes some mild itching, swelling, or burning. This response to an allergen is called allergic contact dermatitis, and it is different than irritant contact dermatitis.

Although the allergic reaction is usually not serious, a person should stop using the product if they suspect that they are allergic to it.

The American Academy of Dermatology (AAD) say that severe allergic reactions to acne products are very rare. However, any signs of a severe systemic allergic reaction require a person to seek immediate medical attention. These signs include:

• trouble breathing
• a swollen or tight throat
• swelling in the face, lips, or tongue
• hives
• feeling faint

Cystic acne

Cystic acne is a severe form of acne that produces cysts deep under the skin. These may appear as painful lumps or very large and red eruptions on the skin. Cystic acne may sometimes cause an itching or tingling sensation.

Some people may find that applying warm or cold compresses directly to the cyst provides relief. However, it is best to avoid applying excessive amounts of acne products on top of the cyst as this may cause more dryness and make irritation and itching worse.

A dermatologist may treat cystic acne with prescription-strength creams, antibiotics, or other medications. In many cases, cystic acne requires treatment with isotretinoin.

Bacterial folliculitis

An acne-like breakout that itches may not be acne at all. According to the AAD, some types of folliculitis may look similar to acne and cause itching.

Folliculitis is an inflammation of the hair follicles, and it is often due to bacteria infecting the follicles. It can cause small, round pimple-like eruptions on hair follicles, and the eruptions may itch.

Staphylococcus aureus is a type of bacterium that may cause bacterial folliculitis. Irritation or inflammation of the hair follicles can allow bacteria inside to cause red bumps. Bacterial folliculitis has a range of causes and risk factors, including:

• using a hot tub, leading to hot tub folliculitis
• excessive rubbing or chafing of the skin
• wearing tight clothing, especially in hot and humid conditions or when exercising
• shaving, waxing, or plucking hair

People can help prevent folliculitis by:

• changing out of wet or tight clothing after exercising
• using a clean, sharp razor for shaving
• avoiding using hot tubs that are not well-maintained

The AAD say that warm compresses can help bring relief from bacterial folliculitis. Keeping the skin clean and dry is also beneficial. A topical benzoyl peroxide wash — 10% for the body or 4% for the face — can often be effective in treating and preventing bacterial folliculitis. However, people should take care when using it as it can bleach fabric and hair.

If the folliculitis does not go away with these remedies, the person should see a dermatologist. The dermatologist may order a test called a bacterial culture and, if necessary, prescribe antibiotics.

Pityrosporum folliculitis

Certain types of fungus can also cause folliculitis. A type of yeast called pityrosporum may produce an itchy, acne-like rash.

Pityrosporum folliculitis may cause red or pink pimple-like bumps to appear on the chest, shoulders, and back. It may be difficult to identify because it looks like acne, but it does not respond well to acne treatments. A characteristic difference between the two conditions is that pityrosporum folliculitis is often very itchy, whereas acne is not.

The American Osteopathic College of Dermatology say that pityrosporum folliculitis happens when there is an overgrowth of yeast on the skin. Possible causes of this overgrowth include:

• wearing synthetic clothing that does not allow the skin to breathe
• using oily skin care products
• having oily skin
• having a lowered immune system
• using steroids, including prednisone
• taking birth control pills
• taking antibiotics
• sweating

Antibacterial products will not treat pityrosporum folliculitis, but some people may find that using antifungal skin products can help. These products include treatments for dandruff, or seborrheic dermatitis, which also occurs as a result of yeast overgrowth.

In addition, a person may find that pityrosporum folliculitis gets better if they keep the skin clean and dry and wear breathable clothing. If the bumps and itching do not go away with these measures, the person should see a dermatologist.

It is best not to ignore acne or rashes that itch. Itching is usually a sign that the skin has become irritated, inflamed, or too dry.

Sometimes, a person can treat itchy acne with one or more of the following home treatments.

Be gentle to skin

If dry skin is causing the itching, switching skin care products can often help.

Many acne products contain irritating or overly drying ingredients. A person should look for cleansers and acne treatment products that are gentle on the skin, which will be those without fragrance, alcohol, harsh scrubs, or very high strength active ingredients. Using these can help keep the skin from drying out and becoming itchy.

A person may also find that applying a noncomedogenic, oil-free moisturizer on top of acne treatments or during different times of the day can help combat dryness and itching.

Avoid scratching or picking pimples

Scratching, picking, or popping pimples can lead to skin damage and permanent scars.

Protect the skin from the sun

Sunlight can damage skin, leading to sunburn and raising the risk of skin cancer. Sunburn can also cause skin peeling and itching.

If a person is using acne treatments, they may need to be even more careful about sun exposure. The AAD state that using acne treatments can make a person more sensitive to sunlight.

To protect the skin, people can wear a broad-spectrum sunscreen of at least SPF 30 and seek shade between the hours of 10 a.m. and 4 p.m.

Get treatment for cystic acne

Cystic acne is not only painful and itchy, but it can also cause permanent scarring and emotional stress.

Cystic acne is very unlikely to clear up with over-the-counter acne treatments. A person should see a dermatologist as soon as possible so that they can begin effective treatment and minimize any chance of permanent scarring.

Try antifungal products on itchy body acne

If itchy acne on the back or chest is not resolving with acne treatments, a person can try applying an antifungal shampoo or skin care product, such as a dandruff shampoo, to the breakout. If the pimples are pityrosporum folliculitis, this may provide relief from itching and help clear up the bumps.